APPLICATION FORM
Important Note
All fields in this form are mandatory. The EPPO reserves the right to disqualify candidates who
do not fill in the Application Form completely and accurately.
Position:
Reference number:
I. PERSONAL DETAILS
Family name:
First name(s):
Correspondence Street: No.:
address
Postal City Country:
code: :
Tel.: Mobile:
Email:
Gender: M: F: Nationality:
(insert ‘X’)
Date of birth: Place of birth:
(dd/mm/yyyy)
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II. PROFESSIONAL EXPERIENCE
(i) Selection criteria
Indicate, giving examples, how you meet each one of the selection criteria (essential and
advantageous) listed in the vacancy notice. Please use lettered listing for the criteria in your response
to match the criteria in the vacancy notice. For any criteria that you would like to leave blank, write
‘n/a’ next to the letter.
The number of words for each criterion should not exceed 200.
Essential
a) …
b) …
c) …
d) …
Advantageous
a) …
b) …
c) …
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(ii) Present or most recent employment
Starting with your present job and continuing in reverse chronological order (present/last job first).
Indicate, with an ‘X’, if you were working full-time (FT) or part-time (PT). If part-time, indicate the
percentage compared to full-time.
Please indicate only the jobs you hold/have held and for which you can provide a certification of the
period actually worked (i.e. contract).
If you include traineeship / internship / fellowship placements, please indicate this in the ‘title of
position’ field and state whether remuneration was given.
From dd/mm/yyyy to dd/mm/yyyy TOTAL yy/mm/dd
FT
PT .....
%
Name and address of
employer:
Exact title of position:
Number and type of staff
under your responsibility:
Description of duties:
May we contact your present employer, if necessary?
(Indicate with an ‘X’) Yes No
Period of notice required to leave your present job:
(iii) Previous employment
From dd/mm/yyyy to dd/mm/yyyy TOTAL yy/mm/dd
FT
3
PT .....
%
Name and address of
employer:
Exact title of position:
Number and type of staff
under your responsibility:
Description of duties:
From dd/mm/yyyy to dd/mm/yyyy TOTAL yy/mm/dd
FT
PT .....
%
Name and address of
employer:
Exact title of position:
Number and type of staff
under your responsibility:
Description of duties:
From dd/mm/yyyy to dd/mm/yyyy TOTAL yy/mm/dd
FT
PT .....
%
Name and address of
employer:
4
Exact title of position:
Number and type of staff
under your responsibility:
Description of duties:
From dd/mm/yyyy to dd/mm/yyyy TOTAL yy/mm/dd
FT
PT .....
%
Name and address of
employer:
Exact title of position:
Number and type of staff
under your responsibility:
Description of duties:
5
From dd/mm/yyyy to dd/mm/yyyy TOTAL yy/mm/dd
FT
PT .....
%
Name and address of
employer:
Exact title of position:
Number and type of staff
under your responsibility:
Description of duties:
From dd/mm/yyyy to dd/mm/yyyy TOTAL yy/mm/dd
FT
PT .....
%
Name and address of
employer:
Exact title of position:
Number and type of staff
under your responsibility:
Description of duties:
From dd/mm/yyyy to dd/mm/yyyy TOTAL yy/mm/dd
FT
PT .....
%
6
Name and address of
employer:
Exact title of position:
Number and type of staff
under your responsibility:
Description of duties:
From dd/mm/yyyy to dd/mm/yyyy TOTAL yy/mm/dd
FT
PT .....
%
Name and address of
employer:
Exact title of position:
Number and type of staff
under your responsibility:
Description of duties:
From dd/mm/yyyy to dd/mm/yyyy TOTAL yy/mm/dd
FT
PT .....
%
Name and address of
employer:
Exact title of position:
Number and type of staff
under your responsibility:
7
Description of duties:
From dd/mm/yyyy to dd/mm/yyyy TOTAL yy/mm/dd
FT
PT .....
%
Name and address of
employer:
Exact title of position:
Number and type of staff
under your responsibility:
Description of duties:
From dd/mm/yyyy to dd/mm/yyyy TOTAL yy/mm/dd
FT
PT .....
%
Name and address of
employer:
Exact title of position:
Number and type of staff
under your responsibility:
8
Description of duties:
From dd/mm/yyyy to dd/mm/yyyy TOTAL yy/mm/dd
FT
PT .....
%
Name and address of
employer:
Exact title of position:
Number and type of staff
under your responsibility:
Description of duties:
Add more tables, if necessary.
III. EDUCATION
a) Formal education: Indicate schools, colleges, universities, or other relevant institutions
attended. Please indicate ONLY the studies for which you have been issued with an official certificate
or diploma.
1) Post-graduate education
From: To: Minimum Title of diploma Name and address
(dd/mm/yyyy) (dd/mm/yyyy) mandatory obtained in original of institution
duration of the language
studies (years):
9
2) Higher education (university)
From: To: Minimum Title of diploma Name and address
(dd/mm/yyyy) (dd/mm/yyyy) mandatory obtained in original of institution
duration of the language
studies (years):
3) Post-secondary education (non-university level)
From: To: Minimum Title of diploma Name and address
(dd/mm/yyyy) (dd/mm/yyyy) mandatory obtained in original of institution
duration of the language
studies (years):
4) Secondary education (or lower)
From: To: Minimum Title of diploma Name and address
(dd/mm/yyyy) (dd/mm/yyyy) mandatory obtained in original of institution
duration of the language
studies (years):
b) Training/courses attended
From: To: (dd/mm/yyyy) Title of diploma obtained Name and address of
(dd/mm/yyyy) institution
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c) Language skills*
Mother tongue:
Other languages: * Written * Spoken * Understanding
English
* Please specify the level, according to the Common European Framework of Reference for
Languages:
http://europass.cedefop.europa.eu/en/resources/european-language-levels-cefr
IV. MOTIVATION FOR APPLYING TO THIS POST (MAX. 500
WORDS)
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DECLARATION OF HONOUR
I declare on my word of honour that the information provided above is true and that I am
aware that any incorrect statements may invalidate my application.
I further declare on my word of honour that:
- I am entitled to my full rights as citizen;
- I have fulfilled any obligations imposed on me by the laws on military service;
- I meet the character requirements for the duties involved;
- I undertake to submit, as soon as requested, any documents in support of the above
statements and declarations;
- I am willing to undergo the prescribed medical examination prior to appointment;
- I undertake to submit, as soon as requested, any documents in support of the above
statements and declarations.
I also declare my commitment to act independently in the Agency's interest and I have no
interests that might be considered prejudicial to my independence.
I understand and accept that my application may be disqualified or rejected in case:
- of failing to comply with any formal requirement stated in this application form and/or in
the related vacancy notice;
- of failing to supply the supporting documents requested following this application and/or
in the related vacancy notice.
I understand that, if it is subsequently discovered that any statement is false or misleading, or I
have withheld relevant information, even if unintentional, my application (or appointment) may
be disqualified, according to the rules laid down in the Staff Regulations.
Name of Applicant ……………………………………………..
Date ……………………………………………..
Signature* ……………………………………………..
* Please be aware that your signature will be requested only if you are invited to an interview.
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